المؤلفون: Ottolini, Martin, Cirks, Blake, Madden, Kathleen B., Rajnik, Michael

المصدر: Current Infectious Disease Reports

مصطلحات موضوعية: Vaccine-preventable diseases (VPD), Infectious Diseases, Conflict, Pediatric Infectious Diseases (I Brook, Section Editor), Displacement, Infections, Children

الوصف: Purpose of Review Armed conflicts occur globally, with some regions experiencing heightened instability for many years. A better understanding of the infectious disease impact on children in armed conflict will allow aid organizations to anticipate and mitigate the most serious problems. Recent Findings Armed conflicts are estimated to have caused approximately 30 million civilian deaths during the past 27 years, with two-thirds occurring in women and children. Children are extremely vulnerable to the mass population displacements, experiencing a combined loss of safety, nutrition, shelter, hygiene, and health care. Under these circumstances, the emergence and prevalence of multiple infectious diseases can result in heightened morbidity and mortality long after active conflict ceases. Summary Factors leading to increased infectious diseases in populations in crisis due to armed conflict and lessons learned from recent outbreaks are discussed in detail. Acute respiratory infections, diphtheria, measles, varicella, and cholera are a few of the more common infectious diseases that take advantage of populations displaced or disrupted by conflict. Key issues include the ability of countries or non-governmental organizations (NGOs) to keep up with basic childhood immunizations, and how rapidly disease outbreaks are recognized and addressed with disease-specific interventions.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9350fcc855a8cd5fceb3d43e7c586eb1Test
https://doi.org/10.1007/s11908-021-00770-1Test

المؤلفون: Matthay, Zachary A, Hellmann, Zane J, Callcut, Rachael A, Matthay, Ellicott C, Nunez-Garcia, Brenda, Duong, William, Nahmias, Jeffry, LaRiccia, Aimee K, Spalding, M Chance, Dalavayi, Satya S, Reynolds, Jessica K, Lesch, Heather, Wong, Yee M, Chipman, Amanda M, Kozar, Rosemary A, Penaloza, Liz, Mukherjee, Kaushik, Taghlabi, Khaled, Guidry, Christopher A, Seng, Sirivan S, Ratnasekera, Asanthi, Motameni, Amirreza, Udekwu, Pascal, Madden, Kathleen, Moore, Sarah A, Kirsch, Jordan, Goddard, Jesse, Haan, James, Lightwine, Kelly, Ontengco, Julianne B, Cullinane, Daniel C, Spitzer, Sarabeth A, Kubasiak, John C, Gish, Joshua, Hazelton, Joshua P, Byskosh, Alexandria Z, Posluszny, Joseph A, Ross, Erin E, Park, John J, Robinson, Brittany, Abel, Mary Kathryn, Fields, Alexander T, Esensten, Jonathan H, Nambiar, Ashok, Moore, Joanne, Hardman, Claire, Terse, Pranaya, Luo-Owen, Xian, Stiles, Anquonette, Pearce, Brenden, Tann, Kimberly, Abdul Jawad, Khaled, Ruiz, Gabriel, Kornblith, Lucy Z

المصدر: The journal of trauma and acute care surgery, vol 91, iss 1

مصطلحات موضوعية: Adult, Male, Physical Injury - Accidents and Adverse Effects, transfusion medicine, Resuscitation, Clinical Sciences, Hemorrhage, Blood Component Transfusion, Nursing, Cardiorespiratory Medicine and Haematology, Trauma, hemorrhagic shock, Injury Severity Score, Trauma Centers, Risk Factors, Clinical Research, Humans, Glasgow Coma Scale, Hospital Mortality, Retrospective Studies, Age Factors, Hematology, Middle Aged, Prognosis, Thrombocytopenia, Emergency & Critical Care Medicine, Treatment Outcome, Good Health and Well Being, Wounds and Injuries, Female

الوصف: BackgroundDespite the widespread institution of modern massive transfusion protocols with balanced blood product ratios, survival for patients with traumatic hemorrhage receiving ultramassive transfusion (UMT) (defined as ≥20 U of packed red blood cells [RBCs]) in 24 hours) remains low and resource consumption remains high. Therefore, we aimed to identify factors associated with mortality in trauma patients receiving UMT in the modern resuscitation era.MethodsAn Eastern Association for the Surgery of Trauma multicenter retrospective study of 461 trauma patients from 17 trauma centers who received ≥20 U of RBCs in 24 hours was performed (2014-2019). Multivariable logistic regression and Classification and Regression Tree analysis were used to identify clinical characteristics associated with mortality.ResultsThe 461 patients were young (median age, 35 years), male (82%), severely injured (median Injury Severity Score, 33), in shock (median shock index, 1.2; base excess, -9), and transfused a median of 29 U of RBCs, 22 U of fresh frozen plasma (FFP), and 24 U of platelets (PLT). Mortality was 46% at 24 hours and 65% at discharge. Transfusion of RBC/FFP ≥1.5:1 or RBC/PLT ≥1.5:1 was significantly associated with mortality, most pronounced for the 18% of patients who received both RBC/PLT and RBC/FFP ≥1.5:1 (odds ratios, 3.11 and 2.81 for mortality at 24 hours and discharge; both p < 0.01). Classification and Regression Tree identified that age older than 50 years, low initial Glasgow Coma Scale, thrombocytopenia, and resuscitative thoracotomy were associated with low likelihood of survival (14-26%), while absence of these factors was associated with the highest survival (71%).ConclusionDespite modern massive transfusion protocols, one half of trauma patients receiving UMT are transfused with either RBC/FFP or RBC/PLT in unbalanced ratios ≥1.5:1, with increased associated mortality. Maintaining focus on balanced ratios during UMT is critical, and consideration of advanced age, poor initial mental status, thrombocytopenia, and resuscitative thoracotomy can aid in prognostication.Level of evidencePrognostic, level III.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od_______325::b2412662cb35867f426fcc9b85353640Test
https://escholarship.org/uc/item/35s2f181Test